Provider Demographics
NPI:1811505480
Name:LEWIS, ANNIE MAE (APRN, RN, COSM)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:MAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN, RN, COSM
Other - Prefix:MRS
Other - First Name:ANNIE
Other - Middle Name:L
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, RN,COSM
Mailing Address - Street 1:1968 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1525
Mailing Address - Country:US
Mailing Address - Phone:706-225-0355
Mailing Address - Fax:
Practice Address - Street 1:1968 NORTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1525
Practice Address - Country:US
Practice Address - Phone:706-315-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN066472363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health